Der Unfallchirurg
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The increasing importance of preventive measures in the field of orthopedics and trauma surgery becomes apparent because of the demographic changes and the high risk for secondary fractures following osteoporotic fractures. Within the fracture treatment chain, orthopedics and trauma surgery are in the "pole position" to initiate these measures in geriatric patients. In the past orthopedists and trauma surgeons have constantly accused of neglecting secondary fracture prevention in fragility fracture patients. ⋯ Self-financing of an FLS is currently possible only in some specific healthcare systems. In healthcare systems in German-speaking areas a cross-financing must be available and the value of an FLS indirectly presented. Apart from the financial aspects, implementation of a FLS is also worthwhile because it can be looked on as the future driving force of innovation.
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In the elderly, fractures and other severe injuries frequently lead to substantial restrictions in the activities of daily living (ADLs) resulting in dependency. Typical complications following a fracture include acute delirium, deep vein thrombosis, pneumonia and other infections. It has been demonstrated that early surgery (osteosynthesis) and early mobilization significantly decrease the risk of these complications. ⋯ The role of the geriatrician in the treatment of orthogeriatric patients includes treatment of internal medical comorbidities, geriatric assessments, coordination of the geriatric team as well as diagnostics and treatment of osteoporosis. In the future, the geriatrician's task will include the preoperative evaluation of orthogeriatric patients, which is already a routine procedure in many orthogeriatric centers. The aim of this article is to summarize the evidence from the currently available literature for interdisciplinary treatment of orthogeriatric patients and to give an overview of the diagnostic and therapeutic interventions relevant to the routine practice for the orthopedic surgeon.
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Randomized Controlled Trial
[Intraoperative virtual implant planning for volar plate osteosynthesis of distal radius fractures.]
Digital planning of implants is in most cases conducted prior to surgery. The virtual implant planning system (VIPS) is an application developed for mobile C-arms, which assists the virtual planning of screws close to the joint line during surgery for treatment of distal radius fractures with volar plate osteosynthesis. The aim of this prospective randomized study was to acquire initial clinical experiences and to compare the VIPS method with the conventional technique. ⋯ The VIPS enables a precise positioning of screws close to joint line in the treatment of distal radius fractures; however, for routine use, further development of the system is necessary.
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Review Meta Analysis
[Geriatric fracture centers : Improved patient care and economic benefits].
The world's population is aging resulting in changes in the way we manage geriatric care. Furthermore, this population has a considerable risk of fragility fractures, most notably hip fractures. Hip fractures are associated with significant morbidity and mortality and have large economic consequences. ⋯ These trauma centers utilize the expertise in orthopedic and geriatric disciplines to provide coordinated care to the elderly hip fracture patient. As a result, studies have demonstrated improvements in clinical outcomes within the hospital stay, a reduction in iatrogenic complications, and improvements in 1-year mortality rates compared to the usual care given at a similar facility. Furthermore, economic models have demonstrated that there is a role for regionalized hip fracture centers that can be both profitable and provide more efficient care to these patients.
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Clinical Trial
[Quality of life and job performance resulting from operatively treated tibial plateau fractures.]
The aim of this article is to present the functional results and the effect on quality of life of surgically treated tibial plateau fractures in physically active and working patients with multiple and serious injuries. In addition, the relationships between functional and radiological outcome were evaluated and compared with activity in daily and professional life. ⋯ The functional and the radiological results were moderate. Quality of life was permanently affected by the consequences of tibial plateau fracture in 12 patients; 11 patients were not re-employed. However, the quality of life was assessed as good or very good and 28 patients had returned to work. The quality of life was firmly linked to the radiological and functional parameters, which tended to be influenced by the quality of the primary surgical treatment when looking at the overall population.